Provider Demographics
NPI:1902530744
Name:WOOLLEY, JOHN-ROBERT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOHN-ROBERT
Middle Name:
Last Name:WOOLLEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 148TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8206
Mailing Address - Country:US
Mailing Address - Phone:425-512-5869
Mailing Address - Fax:
Practice Address - Street 1:13119 SEATTLE HILL RD STE 107
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-3402
Practice Address - Country:US
Practice Address - Phone:425-224-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61282183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist